Tri-Ponderal Mass Index: A Screening Tool for Risk of Central Fat Accumulation in Brazilian Preschool Children

Abstract

Background and Objectives: To verify the use of the tri-ponderalmass index (TMI) as a screening tool for risk of central fat accumulation in preschool children. Materials and Methods: An observational, analytical study was carried out on samples from children 2 to 5 years of age. The body mass index (BMI) and the tri-ponderalmass index (TMI: Weight/height3) were calculated. The waist circumference-to-height ratio (WHtR) was used to classify central fat accumulation risk. Preschoolers whose WHtRwas in the upper tertile of the sample were classified as at risk for central fat accumulation. A comparison of the two indicators (BMI and TMI) was made from the area under the receiver operator characteristics (ROC) curve (AUC) in the discrimination of the WHtR. Results: The sample used for analysis was 919 preschoolers. The mean age of the children was 3.9 years (SD = 0.7). The difference in AUC was 5% higher for TMI (p < 0.0001). In the individual analysis of the ROC curve of the TMI, favoring a higher sensitivity, the cutoff point of 14.0 kg/m3 showed a sensitivity of 99.3% (95% CI: 97.6–99.9). Conclusion: Considering WHtR as a marker of possible future metabolic risk among preschool children, TMI proved to be a useful tool, superior to BMI, in screening for risk of central fat accumulation in preschool children.

Tri-Ponderal Mass Index as a Screening Tool for Identifying Body Fat and Cardiovascular Risk Factors in Children and Adolescents: A Systematic Review

“…It has been shown that percent of body fat (BF%) as a gold standard was better predicted by TMI than by BMI ( 10 , 25 ), although one study reported that both relative fat mass pediatric (RFMp) based on height and waist circumference [WC], and waist-to-height ratio (WHtR) performed better than both TMI and BMI ( 25 ). When WHtR was used to define central obesity as the gold standard, three articles showed that TMI was better than BMI correlated with central fat accumulation in both preschool-aged children aged 2–5 years ( 24 ) and children and adolescents aged 5–17 years ( 19 , 43 ).…”

“…Table 1 describes the characteristics of the included studies including 14 for the association between TMI and body fat in childhood and adolescence (10,14,(18)(19)(20)(21)(22)(23)(24)(25)(26)(41)(42)(43), 20 for TMI and CVRFs in childhood and adolescence (13-18, 21, 26-34, 42-45), and 4 for the association in adulthood (35)(36)(37)46). Twentyfive of the included studies used a cross-sectional design (10, 13, 15-28, 30-34, 41-43, 45), 2 a retrospective design (14,44), 1 a case-control design (29), and 4 a cohort design (35)(36)(37)46).…”

“…A total of 14 articles evaluated the ability of TMI to identify body fat mass in children and adolescents compared with BMI (Table 2) (10,14,(18)(19)(20)(21)(22)(23)(24)(25)(26)(41)(42)(43).…”

“…It is however unclear whether the emerging TMI can better identify adiposity in childhood or adolescence than the commonly used BMI (10,14,(18)(19)(20)(21)(22)(23)(24)(25)(26) and better predict obesity-related cardiovascular risk factors (CVRFs) such as high blood pressure, dyslipidemia, insulin resistance, and the MetS in childhood (13-16, 18, 21, 26-34) or adulthood (35)(36)(37). The misclassification of obesity may lead to either omissions of children who are at high risk of obesity-related diseases or excessive anxiety due to overdiagnosis and then unnecessary waste of medical resources (38).…”

Anthropometric indicators associated with childhood obesity. Is it time for a BMI successor?

“…Również Nascimento i wsp. [61] po przebadaniu brazylijskich dzieci w wieku przedszkolnym uznali, że TMI jest narzędziem, przewyższającym BMI, w ocenie ryzyka centralnego gromadzenia tłuszczu oraz wczesnej identyfikacji dzieci z możliwym ryzykiem chorób sercowo-naczyniowych i przewlekłych chorób niezakaźnych.…”